UTI Treatment Guidelines - Rochester Patient Safety

[Pages:43]UTI Treatment Guidelines

Eric Myers, Pharm.D. PGY-2 Infectious Diseases Pharmacy Resident

Objectives

Evaluate the rationale for new guidelines for the treatment of UTI in long term care Design a treatment regimen for empiric and targeted therapy of UTIs using the new guidelines

2

Rationale for UTI Guideline

1. Improve treatment of UTIs ? Increase likelihood that empiric therapy covers most common causative organisms

2. Reduce incidence of antimicrobial-related adverse events (C. diff) ? Prevent unnecessary prescription of antibiotics ? Reduce prescription of high risk antibiotics (quinolones, 3rd generation cephalosporins)

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Adverse Effects of Fluoroquinolones

GI toxicity CNS toxicity (weakness, confusion, delirium, seizures) QTc prolongation Tendon rupture Clostridium difficile-associated diarrhea Hypo-/hyperglycemia

Increased risk and/or severity in elderly patients

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Owens Jr. RC et al. Clin Infect Dis 2005;41:S144-57

C. Diff and the Elderly

1600

2013 CDI Incidence by Age Group

Incidence (per 100,000 population)

1400

1200

1000

800

600

400

200

0 1-17

18-39

Rochester Emerging Infection Program surveillance data

40-49

50-59

Age Groups

60-69

70-84

85+ 5

Risk of C. diff Infection (CDI) by Antibiotic Class

Retrospective study ? 7,792 patients and 241 cases of CDI ? Risk of CDI compared between antimicrobial classes

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Stevens V et al. Clin Infect Dis 2011;53:42-8

When to Give Antibiotics: Uncatheterized Patients

Positive urine

culture

Symptom criteria

? 105 cfu/mL

? Acute dysuria --OR-? Fever + 1 of following (new or

worsening from baseline): ? Urinary urgency ? Frequency ? Suprapubic pain ? Gross hematuria ? Costovertebral angle tenderness ? Urinary incontinence

**New onset delirium is NOT a symptomatic criterion** 7

Loeb M et al. Infect Control Hosp Epidemiol 2001;22:120-4

When to Give Antibiotics: Indwelling Catheter

Positive urine

culture

? 105 cfu/mL

Symptom criteria

? At least 1 of following (new or worsening from baseline):

? Fever ? New costovertebral tenderness ? Rigors

? New onset delirium not attributable to another cause

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Loeb M et al. Infect Control Hosp Epidemiol 2001;22:120-4

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